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Saturday, April 2, 2011

Scientists only recently learned how certain diseases affect women differently than men, and blacks differently than whites. Now a major new report says it's time to study the unique health needs of gay and transgender people, too.

Stigma often keeps lesbian, gay, bisexual and transgender people from seeking health care — and when they do, there's little research to guide doctors in their treatment, the Institute of Medicine reported Thursday.

Changing that starts with a seemingly simple step: Researchers should start asking people about their sexual orientation and gender identity, just as they routinely ask about race and ethnicity, in all government-funded health studies, the panel concluded.

The report is intended as technical advice to the National Institutes of Health.

But to the gay-rights community, the recommendations from such a prestigious scientific group promise to legitimize a quest for greater health equality.

"This community is just ignored," said Brian Moulton of the Human Rights Campaign, which has long pushed for the government to collect the kind of health data the new report calls for. "This is really going to spark a long-term commitment to dealing with these issues."

While the report says it also is an opportunity to educate the general public about health barriers for the self-named LGBT community, its chairman anticipates some political criticism.

"This is a scientific report, not an advocacy report," said Dr. Robert Graham, professor of family medicine at the University of Cincinnati. "Whatever your politics, as long as you accept the premise that every American ought to have the opportunity for the same health status and the same degree of health, then you really have to understand what the different influences are that may keep certain populations away from having that opportunity."

The IOM panel couldn't even find a good estimate of how many people identify themselves as lesbian, gay, bisexual or transgender. It stressed that these are separate populations that require separate assessments of their health needs at different ages.

Numerous surveys, done by phone or sometimes in person, track Americans' health patterns by a variety of demographics, and the report recommends adding questions about sexual orientation and gender identity to those surveys as a necessary starting point. It also urged particular attention to the impact of stress on LGBT people who may also be part of a racial or ethnic minority group.

California is one of the few states where researchers collect data on LGBT health issues. This week, the UCLA Center for Health Policy Research reported that older gay, lesbian and bisexual Californians are more prone to some problems of aging — including high blood pressure and psychological distress — than their heterosexual counterparts. Moreover, they are more likely to live alone in their senior years, without children or partners to provide care and support.

Nationally, what is known? The AIDS virus remains a threat to young men, particularly black men, who have sex with men, the report noted. But the IOM panel also identified far broader issues: Increased risks of depression, suicide attempts, homelessness and being victims of violence. Possibly higher rates of smoking and substance use. Lesbians and bisexual women may get less preventive care to stay healthy, and have higher rates of obesity and breast cancer.

In addition, laws barring same-sex marriage often limit access to health insurance, and there are few health providers trained to treat transgender patients in particular in a culturally competent manner, the report said.